DYSPHAGIA (DIFFICULTY SWALLOWING)
A problem involving any of the phases of swallowing can result in Dysphagia. Swallowing is the interplay between two separate but related functions, airway protection and bolus transport. Airway protection is the ability to prevent food from entering the trachea (aspiration) while eating. Bolus transports is the transit of food from the mouth into the stomach. All swallowing disorders alter either one or both of these functions. Various diseases, conditions, or surgical interventions can result in swallowing problems.
The symptoms of Dysphagia vary depending on the anatomic location of the pathology. Symptoms include:
- Inability to swallow
- Coughing during or right after eating or drinking
- Regurgitation of food after eating
- Wet sounding voice
- Increased effort or time needed to chew or swallow
- Food or liquid leaking from the mouth
- Food or liquid getting stuck in the mouth, throat or chest
- Recurring pneumonia or chest congestion after eating
- Weight loss or dehydration from not being able to eat enough
- Acid Reflux The reflux of acid into the esophagus or the throat can lead to inflammation resulting in Dysphagia.
- Cricopharyngeal Muscle Dysfunction Disorders of the cricopharyngeal muscle lead to malfunction of the upper esophageal sphincter. This results in difficulty passing food from the throat into the esophagus.
- Foreign Material Objects such as fishbone or pills can get stuck in the throat or esophagus resulting in obstruction or difficulty swallowing.
- Infectious Various bacterial, viral and fungal infections can lead to inflammation resulting in Dysphagia.
- Medications Dysphagia can occur secondary to the use of medications. Sedatives can lead to difficulty swallowing, especially in the elderly. In addition, many medications cause a dry mouth (xerostomia), which can interfere with the oral preparatory phase of swallowing.
- Neurologic Disorders Neurologic disorders such as stokes or Parkinson’s disease may lead to weakness of the swallowing muscles or lack of coordination of the swallowing mechanism.
- Trauma Trauma to the mouth, throat or esophagus may lead to Dysphagia. Injury from burns or surgeries in the area may lead to scarring or decreased movement resulting in difficulty swallowing.
- Tumors Both benign and malignant tumors can lead to difficulty swallowing. Lesions in the mouth, back of the tongue, throat, voice box, esophagus, thyroid, spine and neck can interfere with swallowing. The tumors can involve the anatomical area responsible for a phase of swallowing, obstruct movement of the muscles, or may cause compression from the outside, thus leading to Dysphagia.
- Vocal Cord Paralysis Immobility of the vocal cord alters the swallowing mechanism and may lead to the passage of food into the windpipe (trachea), resulting in aspiration.
- Zenker’s Diverticulum Zenker’s Diverticulum is an out-pouching of a weakened area in the lower throat that collects food and interferes with swallowing.
In addition to a detailed history of the problem and a thorough physical examination, further testing is occasionally necessary to diagnose the source of Dysphagia. Based on the findings, a variety of studies may be recommended:
- Laryngoscopy The throat (pharynx) and voice box (larynx) are visualized with a thin, flexible endoscope that is passed via the nose. Laryngoscopy shows a magnified view of the laryngeal structures and their movement.
- Flexible Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST) Flexible endoscopic evaluation of swallowing with sensory testing evaluates swallowing under direct visualization. A thin, flexible endoscope is passed via the nose, allowing a magnified view of the laryngeal structures and movement. The area is then observed while the patient is eating. In addition, the throat’s ability to sense food is evaluated. The sensation of food is important since it leads to the protection of the airway and thus prevention of transit of food into the windpipe (aspiration).
- Video Swallow Study The patient swallows a variety of liquids and foods mixed with barium, as X-rays of the mouth and throat are taken. These images show how food passes from the mouth through the throat and into the esophagus. The study may help diagnose passage of food into the windpipe (aspiration) or other abnormalities of swallowing.
- Barium Esophagogram The patient swallows a variety of liquids and foods mixed with barium, as X-rays of the esophagus are taken. These images show how food passes from the throat through the esophagus and into the stomach.
- pH Probe Monitoring Sensors placed in various parts of the esophagus measure the level of acidity.
- Esophageal Manometry Sensors placed in the esophagus record pressure changes and muscle contractions.
Treatment depends on the cause, symptoms, and type of the swallowing problem. Patients are often treated by a team of specialists including an ENT physician, speech pathologist and neurologist. Treatment options include swallow therapy, dietary changes, medications, and surgery.
Surgeries of the throat and esophagus are usually performed through the mouth. There is rarely a need for external skin incisions.